Alan E. Gross, PharmD Clinical Assistant Professor University of Illinois Chicago, IL

Unnecessary Antibiotics For Dental Prophylaxis Cause Significant Adverse Events Interview with:

Alan E. Gross, PharmD Clinical Assistant Professor University of Illinois Chicago, IL

Dr. Gross

Alan E. Gross, PharmD
Clinical Assistant Professor
University of Illinois
Chicago, IL What is the background for this study?

Response: Dentists prescribe 10% of all outpatient antibiotics. Most of this prescribing is for infection prophylaxis prior to dental procedures.

Our prior research has found that 80% of prescriptions for dental prophylaxis is unnecessary. Although antibiotic prophylaxis prior to dental procedures is often for a short course (e.g. one time amoxicillin dose), there may be patient harm associated with this. What are the main findings? 

Response: We found that approximately 4% of patients who received unnecessary antibiotic prophylaxis prior to their dental visit experienced a serious adverse event. Most of these adverse events were related to either an ED visit or allergy. Less commonly we saw patients experienced anaphylaxis or C. difficile infection – these two events were rare however are very serious. Importantly, dentists are the top outpatient prescriber of clindamycin and we found that use of this agent was associated with a higher risk of experience and adverse event compared amoxicillin. What should readers take away from your report?

Response: Unnecessary antibiotic prophylaxis prior to dental visits may be associated with patient harm. This, combined with our previous research that found unnecessary antibiotic prophylaxis was common, demonstrate a need to improve antibiotic prescribing for infection prophylaxis in dentistry. To improve antibiotic prescribing, a collaboration between dentists, physicians, pharmacists and patients needs to occur. The CDC core elements of outpatient antibiotic stewardship apply to dentistry and can serve as a model to develop dental antimicrobial stewardship programs. This is an effective approach to improve and standardize prescribing as we have demonstrated in our earlier study (Gross AE, Hanna D, Rowan SA, Bleasdale SC, Suda KJ. OFID. 2019;6(3):ofz067) where we decreased antibiotic use by ~70% for the treatment of oral infections. What recommendations do you have for future research as a result of this work?

Response: There is a need to characterize the reasons behind this unnecessary prescribing and the optimal methods to improve prescribing.

Citation: ID week 2019

Featured Oral Abstract: Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States

Friday, October 4 2019


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Last Updated on October 5, 2019 by Marie Benz MD FAAD